중환자실에서의 병원감염은 일반병동보다 높은 발생률을 보이며 환자 자신의 질병의 중증도와 관련이 있다고 보고되고 있다. 또한 빈번한 치료적 행위와 의식 수준의 저하와 관련이 있어 환자의 중증도를 예측하면 병원감염에 고위험 집단인 중환자를 관리하는데 도움을 줄 수 있다. 이런 예측도구로서 APACHE, Severity-of-illness system, SAPS (Simplified Acute Physiology Score), TISS (Therapeutic Intervention ...
중환자실에서의 병원감염은 일반병동보다 높은 발생률을 보이며 환자 자신의 질병의 중증도와 관련이 있다고 보고되고 있다. 또한 빈번한 치료적 행위와 의식 수준의 저하와 관련이 있어 환자의 중증도를 예측하면 병원감염에 고위험 집단인 중환자를 관리하는데 도움을 줄 수 있다. 이런 예측도구로서 APACHE, Severity-of-illness system, SAPS (Simplified Acute Physiology Score), TISS (Therapeutic Intervention Scoring System) 등이 사용되고 있으나 병원감염과의 관계는 아직까지 정립되어 있지 않은 실정이다. 간호중증도 분류도구는 환자가 제공받는 간호의 양과 간호사의 업무를 양적 개념으로 분류한 도구로서 중증도 점수가 높을수록 환자에게 제공되는 직접간호시간이 증가하는 양의 상관관계를 보인다. 직접간호시간의 증가 할수록 환자에게 접촉하는 시간이 많아져 병원 감염에 노출 될 위험성이 증가한다고 할 수 있다. 따라서 본 연구는 환자의 생리적 변수를 근거로 한 기존의 환자 분류도구 외에 이미 국내의 중환자실에서 보편적으로 사용하고 있는 간호중증도 분류도구를 사용하여 병원감염과의 관계를 조사하고 병원감염의 위험요소를 미리 사정함으로써 감염 발생률을 감소시키기 위한 기초자료를 제시하기 위하여 수행되었다. 서울시에 소재한 3차 의료기관의 내과계중환자실에 2007년 6월1일부터 2008년 3월 31일까지 입원한 환자 중 2일 이상 입원한 성인 환자 477명을 대상으로 한 후향적 서술적 조사연구이다. 간호활동을 8개 항목으로 구분한 간호 중증도 분류도구를 이용하여 매일 0시에 전날의 간호중증도를 조사하고, 병원감염은 연구 대상 병원의 감염관리실에서 자료를 받았으며 최초 병원감염 발생일과 감염종류로 정의하였다. 병원감염률은 1000 환자-일당 감연건수로 계산하였다. 자료 분석은 SPSS - win ver. 12.0 (Chicago, IL) 통계 프로그램을 이용하였다. 연구결과는 다음과 같다. 1. 병원감염이 발생한 환자 수는 72명(15.1%)이고 발생하지 않은 환자는 405명(84.9%)이었다. 진료과별로는 호흡기내과 환자수가 263명(55.1%)으로 가장 많았으며 남자 환자가 327명(68.7%) 이었다. 2. 감염 발생건수는 연환자 1000일당 8.8건이었으며 병원감염률은 15.1%이었다. 감염의 종류는 요로감염 43건(60.0%), 패혈증 26건(34.7%), 기타 감염 5 건(5.3%)이었다. 3. 감염이 발생한 환자의 평균 나이는 62.6±14.세, 남자가 57명(78.1%)로 감염이 발생하지 않은 환자와 비교하여 통계적으로 유의한 차이가 없었다. 중환자실 평균 재실 기간은 감염군이 38.1±34.31일, 비감염군이 13.3±12.8일로 통계적으 로 유의한(p<.001) 차이를 보였다. 감염이 발생하기 전까지의 기간은 평균 22.6±19.2일로 비감염군의 평균 재실 기간인 13.3±12.8일 보다 길어 통계적으 로 유의한(p=.006 차이)를 보였다. 4. 중환자실 입실 당일, 입실 2일, 입실 3일, 퇴실 1일 전의 간호중증도를 환자의 성별, 연령, 진료과, 입실 경로 등에 따라 비교한 결과를 보면 다음과 같다. 입실 당일의 중증도는 타 중환자실을 통해 입실한 경우 105.3±18.4점, 응급실 을 통해 입실한 경우 90.2±2.4점, 병동을 통해 입실한 경우 94.7±25.3점으로 통계적으로 유의한(p<.001) 차이를 보였다. 입실 2일째는 39세 이하의 환자 군이 93.5±26.3점, 40-64세군이 96.4±25.0점, 65-74세군이 100.1±18.8점, 75세 이상이 99.4±16.2점으로 통계적으로 유의한(p=.027) 차이를 보였고, 입실 경로별에서는 병동을 통해 입실한 경우 102.±18.6점, 타 중환자실을 통해 입실한 경우 103.5±15.9점, 응급실을 통해 입실한 경우 96.3±20.5점으로 통계적으로 유의한(p=.002) 차이를 보였다. 입실 3일째는 39세 이하 군에서 91.4±23.8점, 40-64세군이 102.4±19.2점, 65-74세군이 101.5±15.7점, 75세 이상 군이 101.7±15.5점으로 통계적으로 유의한(p=.004) 차이를 보였다. 퇴실 1일 전의 간호중증도는 39세 이하 군에서 88.7±21.2점, 40-64세군이 98.4±19.4점, 65-74 세군이 97.0±20.1점, 75세 이상 군이 68.5±21.점으로 통계적으로 유의한(p=.040) 차이를 보였다. 5. 감염유무에 따른 간호중증도는 입실당일에 감염군이 98.8±21.4점, 비감염군이 95.2±23.7점으로 통계적으로 유의한 차이가 없었으며 입실 2일째에도 감염군이 103.6±18.2점, 비감염군이 99.9±18.9점으로 유의한 차이는 없었다. 입실 3일째는 감염군이 107.0±18.0점, 비감염군이 99.8±17.8점으로 통계적으로 유의한 (p=.002) 차이를 보였으며 퇴실 1일전의 간호중증도는 감염군이 104.2±19.9점,비감염군이 95.8±20.0점으로 유의한(p=.001) 차이를 보였다. 또한 감염군의 감염발생 전날 중증도 점수와 비감염군의 퇴실 1일전 간호중증도를 비교한 결과 108.0±15.3점과 95.8±19.9점으로 유의한(p<.001) 차이를 보였다. 6. 간호중증도를 군으로 분류한 결과 입실 3일째 때 3군은 감염군이 1.4%, 비감염군이 4.5%였고 4군은 감염군이 42.5%, 비감염군이 40.1%였다. 5군은 감염 68.5%, 비감염군이 54.9%였고 6군은 감염군과 비감염군 모두 2.7%로 감염군과 비감염군간에 통계적으로 유의한(p=.021) 차이를 보였다. 7. 감염 종류별 간호중증도 점수는 입실 당일에 요로감염은 100.0±21.7점, 패혈증이 98.4±22.0점, 입실 2일째는 103.4±18.6점, 패혈증이 105.1±18.2점이었고 입실 3일째는 요로감염이 106.2±19.34점, 패혈증이 109.8±16.3점으로. 감염 종류와 간호중증도 점수는 유의한 차이가 없었다. 8. 입실 경로별 간호중증도 점수는 병동을 통해 입실한 경우 입실 당일, 입실 1일, 입실 2일, 입실 3일, 퇴실 1일전에 감염군과 비감염군간에 차이가 없었다. 타 중환자실을 통해 입실한 경우에는 입실 2일째 간호중증도는 감염군이 108.37±8.0점, 비감염군이 102.7±16.7점으로 유의한(p=.018) 차이를 보였다. 응급실을 통해 입원한 경우 입실 당일 감염군이 98.9±14.1점, 비감염군이 88.8±23.2점으로 통계적으로 유의한(p=.007) 차이를 보였고, 입실 3일째는 감염군이 109.5±20.0점, 비감염군이 96.2±19.7점으로 통계적으로 유의한(p=.003) 차이를 보였으며, 퇴실 1일전은 감염군이 110.2±14.0점, 비감염군이 93.8±22.5점으로 통계적으로 유의한(p=.001)차이를 보였다. 결론적으로 병실이나 타 중환자실을 경유하여 중환자실에 입원한 환자들의 간호중증도는 병원 감염군과 비감염군간에 차이가 없었으나, 응급실을 통해 중환자실로 입실한 환자들에게서는 병원감염이 발생한 환자들의 간호중증도가 병원감염이 발생하지 않은 환자들에 비하여 높은 것으로 나타났다.
중환자실에서의 병원감염은 일반병동보다 높은 발생률을 보이며 환자 자신의 질병의 중증도와 관련이 있다고 보고되고 있다. 또한 빈번한 치료적 행위와 의식 수준의 저하와 관련이 있어 환자의 중증도를 예측하면 병원감염에 고위험 집단인 중환자를 관리하는데 도움을 줄 수 있다. 이런 예측도구로서 APACHE, Severity-of-illness system, SAPS (Simplified Acute Physiology Score), TISS (Therapeutic Intervention Scoring System) 등이 사용되고 있으나 병원감염과의 관계는 아직까지 정립되어 있지 않은 실정이다. 간호중증도 분류도구는 환자가 제공받는 간호의 양과 간호사의 업무를 양적 개념으로 분류한 도구로서 중증도 점수가 높을수록 환자에게 제공되는 직접간호시간이 증가하는 양의 상관관계를 보인다. 직접간호시간의 증가 할수록 환자에게 접촉하는 시간이 많아져 병원 감염에 노출 될 위험성이 증가한다고 할 수 있다. 따라서 본 연구는 환자의 생리적 변수를 근거로 한 기존의 환자 분류도구 외에 이미 국내의 중환자실에서 보편적으로 사용하고 있는 간호중증도 분류도구를 사용하여 병원감염과의 관계를 조사하고 병원감염의 위험요소를 미리 사정함으로써 감염 발생률을 감소시키기 위한 기초자료를 제시하기 위하여 수행되었다. 서울시에 소재한 3차 의료기관의 내과계중환자실에 2007년 6월1일부터 2008년 3월 31일까지 입원한 환자 중 2일 이상 입원한 성인 환자 477명을 대상으로 한 후향적 서술적 조사연구이다. 간호활동을 8개 항목으로 구분한 간호 중증도 분류도구를 이용하여 매일 0시에 전날의 간호중증도를 조사하고, 병원감염은 연구 대상 병원의 감염관리실에서 자료를 받았으며 최초 병원감염 발생일과 감염종류로 정의하였다. 병원감염률은 1000 환자-일당 감연건수로 계산하였다. 자료 분석은 SPSS - win ver. 12.0 (Chicago, IL) 통계 프로그램을 이용하였다. 연구결과는 다음과 같다. 1. 병원감염이 발생한 환자 수는 72명(15.1%)이고 발생하지 않은 환자는 405명(84.9%)이었다. 진료과별로는 호흡기내과 환자수가 263명(55.1%)으로 가장 많았으며 남자 환자가 327명(68.7%) 이었다. 2. 감염 발생건수는 연환자 1000일당 8.8건이었으며 병원감염률은 15.1%이었다. 감염의 종류는 요로감염 43건(60.0%), 패혈증 26건(34.7%), 기타 감염 5 건(5.3%)이었다. 3. 감염이 발생한 환자의 평균 나이는 62.6±14.세, 남자가 57명(78.1%)로 감염이 발생하지 않은 환자와 비교하여 통계적으로 유의한 차이가 없었다. 중환자실 평균 재실 기간은 감염군이 38.1±34.31일, 비감염군이 13.3±12.8일로 통계적으 로 유의한(p<.001) 차이를 보였다. 감염이 발생하기 전까지의 기간은 평균 22.6±19.2일로 비감염군의 평균 재실 기간인 13.3±12.8일 보다 길어 통계적으 로 유의한(p=.006 차이)를 보였다. 4. 중환자실 입실 당일, 입실 2일, 입실 3일, 퇴실 1일 전의 간호중증도를 환자의 성별, 연령, 진료과, 입실 경로 등에 따라 비교한 결과를 보면 다음과 같다. 입실 당일의 중증도는 타 중환자실을 통해 입실한 경우 105.3±18.4점, 응급실 을 통해 입실한 경우 90.2±2.4점, 병동을 통해 입실한 경우 94.7±25.3점으로 통계적으로 유의한(p<.001) 차이를 보였다. 입실 2일째는 39세 이하의 환자 군이 93.5±26.3점, 40-64세군이 96.4±25.0점, 65-74세군이 100.1±18.8점, 75세 이상이 99.4±16.2점으로 통계적으로 유의한(p=.027) 차이를 보였고, 입실 경로별에서는 병동을 통해 입실한 경우 102.±18.6점, 타 중환자실을 통해 입실한 경우 103.5±15.9점, 응급실을 통해 입실한 경우 96.3±20.5점으로 통계적으로 유의한(p=.002) 차이를 보였다. 입실 3일째는 39세 이하 군에서 91.4±23.8점, 40-64세군이 102.4±19.2점, 65-74세군이 101.5±15.7점, 75세 이상 군이 101.7±15.5점으로 통계적으로 유의한(p=.004) 차이를 보였다. 퇴실 1일 전의 간호중증도는 39세 이하 군에서 88.7±21.2점, 40-64세군이 98.4±19.4점, 65-74 세군이 97.0±20.1점, 75세 이상 군이 68.5±21.점으로 통계적으로 유의한(p=.040) 차이를 보였다. 5. 감염유무에 따른 간호중증도는 입실당일에 감염군이 98.8±21.4점, 비감염군이 95.2±23.7점으로 통계적으로 유의한 차이가 없었으며 입실 2일째에도 감염군이 103.6±18.2점, 비감염군이 99.9±18.9점으로 유의한 차이는 없었다. 입실 3일째는 감염군이 107.0±18.0점, 비감염군이 99.8±17.8점으로 통계적으로 유의한 (p=.002) 차이를 보였으며 퇴실 1일전의 간호중증도는 감염군이 104.2±19.9점,비감염군이 95.8±20.0점으로 유의한(p=.001) 차이를 보였다. 또한 감염군의 감염발생 전날 중증도 점수와 비감염군의 퇴실 1일전 간호중증도를 비교한 결과 108.0±15.3점과 95.8±19.9점으로 유의한(p<.001) 차이를 보였다. 6. 간호중증도를 군으로 분류한 결과 입실 3일째 때 3군은 감염군이 1.4%, 비감염군이 4.5%였고 4군은 감염군이 42.5%, 비감염군이 40.1%였다. 5군은 감염 68.5%, 비감염군이 54.9%였고 6군은 감염군과 비감염군 모두 2.7%로 감염군과 비감염군간에 통계적으로 유의한(p=.021) 차이를 보였다. 7. 감염 종류별 간호중증도 점수는 입실 당일에 요로감염은 100.0±21.7점, 패혈증이 98.4±22.0점, 입실 2일째는 103.4±18.6점, 패혈증이 105.1±18.2점이었고 입실 3일째는 요로감염이 106.2±19.34점, 패혈증이 109.8±16.3점으로. 감염 종류와 간호중증도 점수는 유의한 차이가 없었다. 8. 입실 경로별 간호중증도 점수는 병동을 통해 입실한 경우 입실 당일, 입실 1일, 입실 2일, 입실 3일, 퇴실 1일전에 감염군과 비감염군간에 차이가 없었다. 타 중환자실을 통해 입실한 경우에는 입실 2일째 간호중증도는 감염군이 108.37±8.0점, 비감염군이 102.7±16.7점으로 유의한(p=.018) 차이를 보였다. 응급실을 통해 입원한 경우 입실 당일 감염군이 98.9±14.1점, 비감염군이 88.8±23.2점으로 통계적으로 유의한(p=.007) 차이를 보였고, 입실 3일째는 감염군이 109.5±20.0점, 비감염군이 96.2±19.7점으로 통계적으로 유의한(p=.003) 차이를 보였으며, 퇴실 1일전은 감염군이 110.2±14.0점, 비감염군이 93.8±22.5점으로 통계적으로 유의한(p=.001)차이를 보였다. 결론적으로 병실이나 타 중환자실을 경유하여 중환자실에 입원한 환자들의 간호중증도는 병원 감염군과 비감염군간에 차이가 없었으나, 응급실을 통해 중환자실로 입실한 환자들에게서는 병원감염이 발생한 환자들의 간호중증도가 병원감염이 발생하지 않은 환자들에 비하여 높은 것으로 나타났다.
It has reported that the rate of healthcare-associated infection is higher in intensive care units than the general ward and that the infection of patients has a relation to severity score of their own diseases. To predict patients' severity can help serious cases who belong to the high-risk group o...
It has reported that the rate of healthcare-associated infection is higher in intensive care units than the general ward and that the infection of patients has a relation to severity score of their own diseases. To predict patients' severity can help serious cases who belong to the high-risk group of healthcare-associated infection, because it is also related to frequent therapeutic cares and lowering of conscious level. Although APACHE, Severity-of-illness system, SAPS (Simplified Acute Physiology Score), and TISS (Therapeutic Intervention Scoring System) have been used as predictive tools, their relationship with healthcare-associated infection has not been clarified yet. A nursing severity scoring system is to classify given amounts and services of nursing in a quantitative respect. It shows a positive correlation that the higher the severity score, the more direct nursing time. As that results in much time to contact with patients, there are, in turn, increasing risk to be exposed to the healthcare-associated infection. Thus, this study was aimed to use nursing severity scoring system, which has generally used in intensive care unit in Korea with existing tool for patient classification based on a physiological factor, investigate the relationship with healthcare-associated infection, and assess previously its risk factor to suggest basic data for reducing the incidence rate. This study was a retrospective and descriptive research for 477 adult patients, who are in medical intensive care unit of the tertiary-care medical institution in Seoul over 2 days from June 1st, 2007 to March 31st, 2008. They were investigated in their previous nursing severity scores every midnight, using the classification tool with 8 items of nursing activities. The healthcare-associated infection data were obtained from the infection control committee and it was defined as dates of origin and infection types. The infection rate was calculated by the number of infection per 1,000 patients-days. The SPSS - win ver. 12.0 Chicago, IL. was used for data analysis. The results of this study are as follows. 1. The number of infected and uninfected patients was 72(15.1%) and 405(84.9%), respectively. By medical departments, the pulmonology had the most patients with 263(55.1%), males were 327(68.7%) among them. 2. The incidence was 8.8 cases per 1,000 patients-days and the rate was 15.1 percent. For the number of infection types, urinary tract infection was 43(60.0%), bloodstream infection was 26(34.7%), and other infections were 5(5.3%). 3. The average age of infected patients was 62.6±14.0, males were 57(78.1%), and there was no significant difference. For days of intensive care unit, infected group was 38.1±34.31 day and uninfected group was 13.3±12.8 days. It indicated some significant differences with p<.001. The average days of period before infection was 22.6±19.2 and longer than the days of uninfected group in hospital (13.3±12.8) 4. For the nursing severity score according to general characteristics on the first day, the score of cases through other intensive care unit was 105.3±18.4, through an emergency room was 90.2±2.4, and through a ward was 94.7±25.3. It was appeared to be significant differences with p<.001. On the second day, the score of the patient group under 39-year-old was 93.5±26.3, from 40 to 64-year-old group was 96.4±25.0, from 65 to 74-year-old group was 100.1±18.8, and the group over 75-year-old was 99.4±16.2. There were significant differences with p=.027. For the route of ICU admission, the score of cases through a ward was 102.0±18.6, through other intensive care unit was 103.5±15.9, and through an emergency room was 96.3±20.5. It showed very significant differences with p=.002. On the third day, the score of the patient group under 39-year-old was 91.4±23.8, from 40 to 64-year-old group was 102.4±19.2, from 65 to 74-year-old group was 101.5±15.7, and the group over 75-year-old was 101.7±15.5. There were significant differences with p=.004. For the nursing severity score on 1 day before discharge from ICU, the score of the patient group under 39-year-old was 88.7±21.2, from 40 to 64-year-old group was 98.4±19.4, from 65 to 74-year-old group was 97.0±20.1, and the group over 75-year-old was 68.5±21.3. There were significant differences with p=.040. 5. For the nursing severity score according to the existence of infection, the score of infected and uninfected group was 98.8±21.4 and 95.2±23.7, respectively, on the first day. There was no significant difference. On the second day of admission, infected and uninfected group was 103.6±18.2 and 99.9±18.9, respectively. It also showed no significant difference. On the third day, infected and uninfected group was 107.0±18.0 and 99.8±17.8, respectively. It showed a significant difference with p=.002. For the nursing severity score on 1 day before leaving, infected and uninfected group was 104.2±19.9 and 95.8±20.0, respectively. There were very significant differences with p=.001. Comparing the score of infected group on 1 day before infection with uninfected group on 1 day before discharge from ICU showed a very significant difference (p< .001) with 108.0±15.3 and 95.8±19.9, respectively. 6. The nursing severity score was classified into groups. The results showed that, on the third day, infected and uninfected group in the group 3 was 1.4 and 4.5 percent, respectively. In the group 4, infected and uninfected group was 42.5 and 40.1 percent, respectively. In the group 5, infected and uninfected group was 68.5 and 54.9 percent, respectively. In the group 6, both infected and uninfected group were 2.7 percent. There was a significant difference with p=.021. 7. For the nursing severity score according to infection types, urinary tract infection was 100.0±21.7 and bloodstream infection was 98.4±22.0 on the 1st day. On the 2nd day, the score of urinary tract infection was 103.4±18.6 and bloodstream infection was 105.1±18.2. On the 3rd day, the score of urinary tract infection was 106.2±19.34 and blood poisoning was 109.8±16.3. There was no significant difference. 8. For the nursing severity score according to routes of ICU admission, infected group was 91.5±24.5 and uninfected group was 94.6±25.5 through a ward on the 1st day. It showed no statistically significant difference. The nursing severity score of infected and uninfected group was 108.37±8.0 and 102.7±16.7, respectively, through other intensive care unit on the 2nd day. It showed a significant difference with p=-.018. In case of groups through an emergency room, infected and uninfected group was 98.9±14.1 and 88.8±23.2, respectively, it showed a significant difference with p=.007. The score of infected group was 109.5±20.0 and uninfected group was 96.2±19.7 on the 3rd day. It showed a significant difference with p=.003. The score of infected and uninfected group was 110.2±14.0 and 93.8±22.5, respectively, on 1 day before leaving. It showed a significant difference with p=.001. The conclusion was that in case of healthcare-associated infection, the nursing severity score was higher in infected group on the 3rd day and 1 day before leaving. The patients, who were through an emergency room and infected from the 1st day to the 3rd day, had a higher nursing severity score. It can be an opportunity to reduce the incidence of healthcare-associated infection by caring intensively the patient who was in intensive care unit and had a high nursing severity score on the 3rd day with stabilized nursing and treatment.
It has reported that the rate of healthcare-associated infection is higher in intensive care units than the general ward and that the infection of patients has a relation to severity score of their own diseases. To predict patients' severity can help serious cases who belong to the high-risk group of healthcare-associated infection, because it is also related to frequent therapeutic cares and lowering of conscious level. Although APACHE, Severity-of-illness system, SAPS (Simplified Acute Physiology Score), and TISS (Therapeutic Intervention Scoring System) have been used as predictive tools, their relationship with healthcare-associated infection has not been clarified yet. A nursing severity scoring system is to classify given amounts and services of nursing in a quantitative respect. It shows a positive correlation that the higher the severity score, the more direct nursing time. As that results in much time to contact with patients, there are, in turn, increasing risk to be exposed to the healthcare-associated infection. Thus, this study was aimed to use nursing severity scoring system, which has generally used in intensive care unit in Korea with existing tool for patient classification based on a physiological factor, investigate the relationship with healthcare-associated infection, and assess previously its risk factor to suggest basic data for reducing the incidence rate. This study was a retrospective and descriptive research for 477 adult patients, who are in medical intensive care unit of the tertiary-care medical institution in Seoul over 2 days from June 1st, 2007 to March 31st, 2008. They were investigated in their previous nursing severity scores every midnight, using the classification tool with 8 items of nursing activities. The healthcare-associated infection data were obtained from the infection control committee and it was defined as dates of origin and infection types. The infection rate was calculated by the number of infection per 1,000 patients-days. The SPSS - win ver. 12.0 Chicago, IL. was used for data analysis. The results of this study are as follows. 1. The number of infected and uninfected patients was 72(15.1%) and 405(84.9%), respectively. By medical departments, the pulmonology had the most patients with 263(55.1%), males were 327(68.7%) among them. 2. The incidence was 8.8 cases per 1,000 patients-days and the rate was 15.1 percent. For the number of infection types, urinary tract infection was 43(60.0%), bloodstream infection was 26(34.7%), and other infections were 5(5.3%). 3. The average age of infected patients was 62.6±14.0, males were 57(78.1%), and there was no significant difference. For days of intensive care unit, infected group was 38.1±34.31 day and uninfected group was 13.3±12.8 days. It indicated some significant differences with p<.001. The average days of period before infection was 22.6±19.2 and longer than the days of uninfected group in hospital (13.3±12.8) 4. For the nursing severity score according to general characteristics on the first day, the score of cases through other intensive care unit was 105.3±18.4, through an emergency room was 90.2±2.4, and through a ward was 94.7±25.3. It was appeared to be significant differences with p<.001. On the second day, the score of the patient group under 39-year-old was 93.5±26.3, from 40 to 64-year-old group was 96.4±25.0, from 65 to 74-year-old group was 100.1±18.8, and the group over 75-year-old was 99.4±16.2. There were significant differences with p=.027. For the route of ICU admission, the score of cases through a ward was 102.0±18.6, through other intensive care unit was 103.5±15.9, and through an emergency room was 96.3±20.5. It showed very significant differences with p=.002. On the third day, the score of the patient group under 39-year-old was 91.4±23.8, from 40 to 64-year-old group was 102.4±19.2, from 65 to 74-year-old group was 101.5±15.7, and the group over 75-year-old was 101.7±15.5. There were significant differences with p=.004. For the nursing severity score on 1 day before discharge from ICU, the score of the patient group under 39-year-old was 88.7±21.2, from 40 to 64-year-old group was 98.4±19.4, from 65 to 74-year-old group was 97.0±20.1, and the group over 75-year-old was 68.5±21.3. There were significant differences with p=.040. 5. For the nursing severity score according to the existence of infection, the score of infected and uninfected group was 98.8±21.4 and 95.2±23.7, respectively, on the first day. There was no significant difference. On the second day of admission, infected and uninfected group was 103.6±18.2 and 99.9±18.9, respectively. It also showed no significant difference. On the third day, infected and uninfected group was 107.0±18.0 and 99.8±17.8, respectively. It showed a significant difference with p=.002. For the nursing severity score on 1 day before leaving, infected and uninfected group was 104.2±19.9 and 95.8±20.0, respectively. There were very significant differences with p=.001. Comparing the score of infected group on 1 day before infection with uninfected group on 1 day before discharge from ICU showed a very significant difference (p< .001) with 108.0±15.3 and 95.8±19.9, respectively. 6. The nursing severity score was classified into groups. The results showed that, on the third day, infected and uninfected group in the group 3 was 1.4 and 4.5 percent, respectively. In the group 4, infected and uninfected group was 42.5 and 40.1 percent, respectively. In the group 5, infected and uninfected group was 68.5 and 54.9 percent, respectively. In the group 6, both infected and uninfected group were 2.7 percent. There was a significant difference with p=.021. 7. For the nursing severity score according to infection types, urinary tract infection was 100.0±21.7 and bloodstream infection was 98.4±22.0 on the 1st day. On the 2nd day, the score of urinary tract infection was 103.4±18.6 and bloodstream infection was 105.1±18.2. On the 3rd day, the score of urinary tract infection was 106.2±19.34 and blood poisoning was 109.8±16.3. There was no significant difference. 8. For the nursing severity score according to routes of ICU admission, infected group was 91.5±24.5 and uninfected group was 94.6±25.5 through a ward on the 1st day. It showed no statistically significant difference. The nursing severity score of infected and uninfected group was 108.37±8.0 and 102.7±16.7, respectively, through other intensive care unit on the 2nd day. It showed a significant difference with p=-.018. In case of groups through an emergency room, infected and uninfected group was 98.9±14.1 and 88.8±23.2, respectively, it showed a significant difference with p=.007. The score of infected group was 109.5±20.0 and uninfected group was 96.2±19.7 on the 3rd day. It showed a significant difference with p=.003. The score of infected and uninfected group was 110.2±14.0 and 93.8±22.5, respectively, on 1 day before leaving. It showed a significant difference with p=.001. The conclusion was that in case of healthcare-associated infection, the nursing severity score was higher in infected group on the 3rd day and 1 day before leaving. The patients, who were through an emergency room and infected from the 1st day to the 3rd day, had a higher nursing severity score. It can be an opportunity to reduce the incidence of healthcare-associated infection by caring intensively the patient who was in intensive care unit and had a high nursing severity score on the 3rd day with stabilized nursing and treatment.
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